Trilogy vs 100 W Ho: YAG Laser for Lithotripsy in Mini-Percutaneous Nephrolithotomy: Superior Stone-Free Rates in a...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithotomy

Background:

• Mini-percutaneous nephrolithotomy (Mini-PCNL) is a key procedure for kidney stone management.
• Comparing different lithotripsy technologies is crucial for optimizing stone clearance and patient outcomes.

Purpose of the Study:

• To compare the clinical outcomes of 100W Ho:YAG laser and Trilogy lithotripter in Mini-PCNL.
• To determine the most effective method for stone clearance via a miniaturized percutaneous tract.

Main Methods:

• A double-blind, randomized, single-center controlled trial (NCT04559321) included patients with GUY's grade 1-2 kidney stones.
• Participants were randomized to Mini-PCNL using either a 100W Ho:YAG laser or a 1.5mm Trilogy lithotripter.
• Primary endpoints included stone lithotripsy time, lithotripsy rate, and stone-free rate. Study terminated early due to efficacy in one arm.

Main Results:

• Eighty-three patients were analyzed; Trilogy achieved a significantly higher stone-free rate (88.4% vs 70%, P=.038).
• Mean stone lithotripsy time (8.02 vs 5.7 min) and lithotripsy rate (179 vs 212 mm³/min) showed no significant difference between groups.
• Complication rates were low and comparable (2.3% Trilogy vs 10% laser, P=.142), with no significant difference in residual stone volume.

Conclusions:

• Trilogy lithotripsy offers a higher stone-free rate in Mini-PCNL compared to high-power laser lithotripsy.
• The Trilogy lithotripter is an effective alternative for stone clearance, particularly when active suction is unavailable.
• The study supports Trilogy's utility in Mini-PCNL without increasing operative time or complications.